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April is National Child Abuse Awareness Month

By Rachel Olis

Child abuse is more than bruises and broken bones. While physical abuse might be most visible, other types of abuse, such as emotional abuse or child neglect, also leave deep, long lasting scars. Some signs of child abuse are subtler than others. Since April is National Child Abuse Awareness Month, the experts at Children’s of Alabama want to remind you of the importance of recognizing and reporting abuse of any kind.

“By learning common types of abuse and what you can do, you can make a huge difference in a child’s life,” says Deb Schneider, director of Children’s Hospital Intervention and Prevention Services, or the CHIPS Center at Children’s of Alabama. “The earlier abused children get help, the greater chance they have to heal from their abuse and not perpetuate the cycle.”

The four types of child abuse are:
• Physical Abuse
• Sexual Abuse
• Emotional Abuse
• Neglect

In Alabama, one in six kids are physically abused every year and as many as 25 percent of children will be sexually abused by the time they reach age 18. Physical abuse is the leading cause of death under the age of 3.

Neglect remains the highest reported form of abuse in our state.

The signs of child abuse vary depending on the type of abuse, but there are some common indicators:

Warning signs of emotional abuse in children:
• Excessively withdrawn, fearful or anxious about doing something wrong.
• Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive).
• Doesn’t seem to be attached to the parent or caregiver.
• Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, tantrums).
Warning signs of physical abuse in children:
• Frequent injuries or unexplained bruises, welts, or cuts.
• Is always watchful and “on alert,” as if waiting for something bad to happen.
• Injuries appear to have a pattern such as marks from a hand or belt.
• Shies away from touch, flinches at sudden movements, or seems afraid to go home.
• Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Warning signs of neglect in children:
• Clothes are ill-fitting, filthy, or inappropriate for the weather.
• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).
• Untreated illnesses and physical injuries.
• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.
• Is frequently late or missing from school. Read more

National Poison Prevention Week: Danger of Disc Batteries

disc_batteriesBy: Ann Slattery, DrPH, RN, RPh, CSPI, DABAT, Managing Director, Regional Poison Control Center at Children’s of Alabama

There are many objects throughout a household that children can swallow, but one particular object that has warranted many calls to the Regional Poison Control Center at Children’s of Alabama (RPCC) are disc batteries, which can easily be mistaken for a quarter or other coins. The RPCC at Children’s of Alabama has received 60 exposure calls related to disc batteries in the last three years with no fatalities.

Disc batteries are round flat batteries that range in size from a pencil eraser to a quarter (5 mm – 20 mm) that are used in watches, calculators and hearing aids. The majority of exposures to disc batteries occur in curious children.

From 1985-2009, 56,535 disc battery ingestions were reported to the National Poison Data System. Fortunately, deaths after swallowing a disc battery are rare, less than 0.02 percent. However, these ingestions are serious, so it is important to be aware of the symptoms of possible poisoning. These symptoms include cough, wheezing, irritability, poor appetite, vomiting, lethargy, fever and dehydration.

More often than not, the caregiver did not see the ingestion of the disc battery, but if a disc battery is swallowed, an X-ray is needed to find its location in the body. Only then can appropriate recommendations be made.

  • If the battery has moved beyond the esophagus, most will pass uneventfully through the rest of the digestive system and pass within a matter of few days.
  • If the battery is lodged in the esophagus, it is considered an emergency and requires immediate removal.
  • A disc battery becoming lodged beyond the esophagus is unlikely, but if it happens, burns may occur resulting in tissue damage and internal bleeding, causing in a medical emergency.

The majority of disc battery ingestions occur immediately after the battery is removed from the object, but discarded or loose batteries also account for a fair amount of ingestions. It is very important to keep disc batteries out of reach and out of sight!

National Poison Prevention Week is March 16 – 22, 2014. The themes are “Children Act Fast…So Do poisons!” and “Poisoning Spans a Lifetime.” While pediatric (less than 6 years of age) exposures account for 52 percent of The Regional Poison Control Centers (RPCC) at Children’s of Alabama human exposures; adults also experience poisoning with adult exposures accounting for 32 percent of the call volume.  The RPCC received 37,842 calls in 2013 including more than 24, 000 human exposures with more than 44,000 follow up calls. In 2014 the RPCC expects to receive 58,000 calls with 38,000 human exposures. The RPCC is available 24/7 at 1-800-222-1222.

Too Much Screen Time?

By: Rachel Olis

Children growing up today spend more time with technology than any previous generation. Unfortunately, this also means that they spend more time sitting in front of a screen. But at what point have the kids had too much? From tablets and cell phones to TV’s and laptops, children have a lot of opportunity for screen time. Although there are educational programs and apps, the negative effects of having too much media exposure seem to outweigh the positive.

“On average kids spend about seven hours a day on media, but we’d really prefer to see kids playing,” said Dr. Dan Marullo, pediatric neuropsychologist at Children’s of Alabama.

The American Academy of Pediatrics (AAP) recommends that children under the age of 2 not watch any television and that older kids have no more than two hours of screen time per day.

“If you are starting to see your child not spending as much time interacting with other families or friends, not playing, not engaging in favorite activities, research shows that there can be a link between too much media exposure and obesity and hypertension,” he said.

Problems paying attention and concentrating, depression or anxiety, and even aggression can also be signs that your child has had too much media exposure.

Here are a few ways to limit children’s screen time:

  • Limit the number of screen time hours.
  • When a program is over, turn the television off instead of surfing the channels.
  • Set up a “media free zone” that includes bedrooms and the kitchen during dinner.
  • Make a screen time schedule that all members of the family abide by.
  • Make watching television a family affair.
  • Set a good example. Put down your cell phone and exchange watching television for something active.

Fortunately, there are many alternatives to the screen. Here are some examples:

  • Send your kids outside to play, or go play with them!
  • Involve them in a sport such as baseball, ballet, lacrosse or swimming.
  • Have a family game night – play board games and cards.
  • Sit down and read together.

The amount of fun activities you and your kids can do without the TV and tablets are endless. For more information on how to have healthy screen time habits, visit http://www.childrensal.org.

Medical specialists at Children’s of Alabama use teamwork and technology for cardiovascular care

By Yung Lau, MD

Dr. Yung LauChildren’s of Alabama recently marked one year since pediatric cardiovascular services moved into the new Joseph S. Bruno Pediatric Heart Center from University of Alabama Hospitals. This move has markedly improved the scope and delivery of care. The program has been the primary referral point for patients with pediatric and congenital heart disease from throughout the state but the move has allowed us to progress quickly to advance the care of our patients further and more completely.

Two elements have contributed to this progress: Our technology and our team.

Our new facility provides one of the best platforms for care in the world. We have the latest equipment in the right configuration. First, the Bruno Heart Center is really a heart hospital within a hospital — located on the entire fourth floor of the Benjamin Russell Hospital for Children.

The center includes a 20-bed intensive care unit, a 16-bed telemetry ward, two dedicated cardiovascular surgical suites, two catheterization labs; one of which is a “hybrid” room where a patient can undergo surgery and catheterization simultaneously. The intensive care unit has four rooms dedicated to extracorporeal membrane oxygenation (ECMO), which is similar to the heart bypass process often used during cardiac surgery.

Having all these facilities and equipment located on one floor is critical for the care and comfort of our cardiovascular patients. Operating rooms are near catheterization labs. And they are on the same floor as the hybrid room and the ICU. So children who are on many intravenous medications and even on ECMO can be moved among any of these rooms without ever having to switch floors. That is really, really huge. Our intensive care unit used to be housed in a large, single room. Now, there are private rooms with space for parents to stay while their child is hospitalized.

While the facilities are world-class, we are just as proud of the multispecialty, multidisciplinary team that has been assembled to deliver comprehensive care. Cardiologists, surgeons, intensivists and anesthesiologists all work together. It’s not just in name only. Every one of those specialties is dedicated solely to the care of children with heart disease. I don’t know if there is any other field where there is such a close alliance and such teamwork among so many different specialties.

Keeping Your Child’s Teeth Healthy

By Rachel Olis

When should I schedule my child’s first trip to the dentist? Should my 3-year-old be flossing? How do I know if my child needs braces?

Many parents have a tough time judging how much dental care their kids need. They know they want to prevent cavities, but they don’t always know the best way to do so.

When Should Dental Care Start?
Proper dental care begins even before a baby’s first tooth appears. Remember that just because you can’t see the teeth doesn’t mean they arent there. Teeth actually begin to form in the second trimester of pregnancy. At birth, your baby has 20 primary teeth, some of which are fully developed in the jaw.

Running a damp washcloth over your baby’s gums following feedings can prevent buildup of damaging bacteria. Once your child has a few teeth showing, you can brush them with a soft child’s toothbrush or rub them with gauze at the end of the day.

Parents and childcare providers should help young kids set specific times for drinking each day because sucking on a bottle throughout the day can be equally damaging to young teeth.

Pediatric Dentists
Consider taking your child to a dentist who specializes in treating kids. Pediatric dentists are trained to handle the wide range of issues associated with kids’ dental health. They also know when to refer you to a different type of specialist such as an orthodontist to correct an overbite or an oral surgeon for jaw realignment.

A pediatric dentist’s primary goals are prevention -heading off potential problems before they occur, and maintenance- using routine checkups and proper daily care to keep teeth and gums healthy.

The American Dental Association (ADA) and the experts at Children’s recommend that a child’s first visit to the dentist take place by their first birthday. At this visit, the dentist will explain proper brushing and flossing techniques (you need to floss once your baby has two teeth that touch) and conduct a modified exam while your baby sits on your lap.

Such visits can help in the early detection of potential problems, and help kids become accustomed to visiting the dentist so they’ll have less fear about going as they grow older.

Brushing at least twice a day and routine flossing will help maintain a healthy mouth. Kids as young as age 2 or 3 can begin to use toothpaste when brushing, as long as they’re supervised. Kids should not ingest large amounts of toothpaste.

If Your Child Has a Problem
If you are prone to tooth decay or gum disease, your kids may be at higher risk as well. Therefore, sometimes even the most diligent brushing and flossing will not prevent a cavity. Be sure to call your dentist if your child complains of tooth pain, which could be a sign of a cavity that needs treatment.

To schedule a visit with the Dental Clinic at Children’s, please call 205-638-9161.

Dr. Sri Explains It All: When to Worry About a Fever

By Dr. Sri Narayanan

Fevers can be scary. Your child has all the energy knocked out of him, he’s panting and sweaty and clammy and fussy all at the safeverme time. As dangerous as they may seem, fevers are simply the body’s way to rev up the immune system and kill the viruses or bacteria that are causing an infection – with the side effect of making you feel lousy. Thankfully, most children with fevers have viruses that just need to run their course, and they can be managed at home without needing to see a doctor for further testing.

Most doctors define fever as a temperature over 100.4 degrees Fahrenheit (38 degrees Celsius), measured rectally in infants and under the armpit or tongue in older children. We see a lot of kids in the Emergency Department for fever, and our advice is usually the same:

  • Give them plenty of fluids
  • Let them rest
  • Try some acetaminophen or ibuprofen if they cannot get comfortable

Here are a couple of situations where you may want to seek medical attention:

  • Fever in an infant under 2 months of age. Little babies with a cold start off the same way as little babies with severe infections, so we recommend that any infant under 2 months with a fever gets an evaluation in the Emergency Department.
  • Fever for more than five days. Some viruses like influenza and EBV (the virus that causes mono) can cause fever for a week, but an illness that lasts this long is unusual enough that you should see your pediatrician.
  • Fever and vomiting / abdominal pain. If the pain is bad enough that the usual over-the-counter medicine is not helping, or if your child cannot even keep down sips of fluids, they are at high risk for dehydration and should be seen by a physician.
  • Fever and difficulty breathing. As I wrote about in last month’s blog post, bronchiolitis season is here, and we saw several kids with the flu. Rapid breathing or pulling in at the neck/ribs is a reason to get checked out sooner rather than later.

Contrary to what you may hear, fevers do not cause brain damage, no matter how high the temperature gets. In a small percentage of kids under age six, fevers can cause seizures, but these almost always stop on their own and have no long-term effects. If your child is seen in our Emergency Department for a febrile seizure, we have an informative video all about seizure facts and first aid.

Fevers are a natural part of healing and are the sign of a strong immune system. They can certainly be uncomfortable, but they are rarely dangerous. Follow the tips above to help your child recover as quickly as possible, and to know when it’s important to seek medical attention.

Winter Safety and Kids

By Rachel Olis

At this time of year, even in Alabama, we can expect some low temperatures. Cold weather does not necessarily mean you need to keep your kids cooped up inside- However; it’s important to remember some general safety tips this winter, regardless of whether your family stays inside or ventures out.

Many kids don’t like the idea of wearing a heavy coat and may claim they aren’t cold. According to Christina Fettig, pediatrician at Children’s of Alabama, children are just as susceptible to the cold as adults are.

“The American Academy of Pediatrics recommends several layers,” she said. “The best rule of thumbs is to dress your children in one more layer than we as adults wear.”

Help keep your kids safe indoors and outdoors with these tips:

  • “Just like in the summer, dehydration can still occur,” Fettig said. She recommends drinking water as the best way to keep kids hydrated while outdoors.
  •  Instead of heavy materials, choose lighter, cold-weather fabrics like polyester fleece that are easier for children to move around in. This allows kids to take off layers when they get warm and add additional layers when they get cold.
  •  Make sure kids cover exposed areas like hands, ears and heads.
  •  Snow can reflect up to 85 percent of the sun’s ultraviolet rays, so sunscreen is still important even in winter weather.
  •  Fettig advises being cautious with space heaters in the home.“The Centers for Disease Control and Prevention show carbon monoxide poisoning is highest in January.” She added that only one-third of homes have a carbon monoxide detector.
  •   To keep children’s skin from drying out from the cold air, Fettig advises not bathing young children every day. “We recommend if a child is less than one, don’t bathe them more than 2-3 times per week.” For older children who spend more time outdoors, she recommends a gentle, perfume-free moisturizer.

Merry Moderation

Jordan-iceCreamThe holidays don’t always feel like holidays without favorite foods, which can make them especially difficult for diabetic kids and their families. If your family’s traditional favorites seem like a recipe for disaster, Children’s nutritionist Rainie Carter has three simple tips to keep your celebrations healthy and fun:

1) Keep track of carbs (carbohydrates)

You’ll want to help your child make lower fat choices to stay healthy on a daily basis. But on a holiday, Carter says, “We’re really just focused on the carbs.”

Accurately counting carbs is one of the things families struggle with around the holidays, Carter explains, but online and smartphone resources to make it easier than ever. Sites like calorieking.com and gomeals.com help identify the carbohydrate counts in common foods, and both sites offer free smartphone apps for quick reference on the go. Gomeals.com was created with diabetics in mind, and it offers extra resources like blood sugar tracking.

For multi-ingredient dishes prepared at home, sparkrecipes.com has a handy recipe calculator that does the counting for you. Keep in mind that these counts depend on accurate serving measures, so you’ll have to be aware when dishing out servings.

Some holiday foods are surprisingly easy to adjust for a lower carbohydrate load. “You can make a lot of the pies a lot more diabetes-friendly by just using a sugar substitute,” Carter notes. “If you use sucralose (Splenda®) it doesn’t really change the consistency or alter the baking in any way.” Making your pie crust-less can save even more carbs.

2) Enjoy some favorites

Remember that the holidays should feel special and it’s okay to indulge a little. Carter recommends that kids stick to three or four of their favorite items in the main meal and one or twosmall desserts. Fill half the plate with non-starchy vegetables and lean protein to fill up on lower carb options. A half-cup serving is a good limit for higher calorie items. (But don’t worry about bringing a measuring cup to holiday dinners: A half-cup serving is roughly the size of a fist.)

Some holiday favorites actually have reasonable carb counts in small servings. Mashed potatoes, for instance, have so much milk and butter that the carb load is only around 15 grams of carbohydrates per half cup. Green bean casserole is another decent option at roughly 12 grams of carbs per half cup. (Macaroni and cheese and cornbread dressing have higher amounts of carbs and should be eaten in moderation, since a one cup serving can add up to more than 50 grams of carbohydrates.) Read more

Handling Holiday Hazards

By Dr. Mom (Terri Coco, MD)

As a mom, seeing children in the emergency room for preventable holiday-related injuries is heartbreaking. Often, I see cuts to the body or mouth from broken ornaments and decorations, plant ingestions and burns from cooking in the home. During what is often referred to as “the most wonderful time of the year” be smart and be safe by avoiding holiday hazards. Always remember the age of the children that are going to be in the home and plan, decorate, cook and gift accordingly!

O Christmas Tree, O Christmas Tree
A Christmas tree is a big part of the holidays in many households. However, they do come with some risks. The National Child Protection Association and the U.S. Fire Administration estimate that there are 240 home fires from Christmas trees and 150 home fires from holiday lights and decorations each year. When buying a Christmas tree, make sure it is fresh.  Check to see that the needles are green and hard to pull off and that the stump is sticky with sap. Put the tree in a place that is away from heat sources that may cause it to catch fire. Water live trees daily. When the tree starts to turn brown or the needles get dry and are easy to pull off, it is time to remove it from the home. If you choose an artificial tree, look for one that is flame resistant.

Decking the Halls
As you jingle all the way this year, be aware of the potential dangers of holiday decorations. The same sparkle, pop and twinkle that you enjoy about your decorations will also be appealing to small children.

Candles – Everyone likes to have pretty holiday candles around their home but they are very dangerous if left unattended. In the last few years LED candles have hit the market – they are a good alternative to the real thing. If you choose real candles, keep them out of reach of younger children.

Ornaments and Tinsel - Ornaments and tinsel can be a choking hazard for small children. Always hang them high and out of reach of children who may want to pull on them. Many tree decorations can look like food – this is especially appealing to children. Anything that can fit into a toilet paper roll can be a choking hazard for a small child. Also be careful with ornament hooks as they can cut or puncture the skin.

Lights – Be sure to purchase lights that indicate on the packaging that they are approved by a testing lab. Test light strands every year to make sure that there are no exposed wires or sockets. Always turn decorative lights off before leaving home and before going to bed at night. Keep lights out of reach of small children, as chewing on a light strand could cause the child to get shocked or electrocuted. Remember glass bulbs are also a hazard if broken. Replace your holiday lights every few years. Read more

Dr. Sri Explains Bronchiolitis

By Dr. Sri Narayanan, MD

It’s autumn. The weather is getting cooler, the leaves are changing colors and here at Children’s of Alabama, the gloves and gowns are on for bronchiolitis season.

Bronchiolitis is a viral respiratory illness that affects children under two years of age, most often between November and February. Viruses such as Respiratory Syncytial Virus (RSV) and influenza are the most common causes and full healing could take two weeks or more. The symptoms of bronchiolitis usually follow this timeline:

  • Days 1-3: coughing and nasal congestion with low-grade fevers
  • Days 4-7: wheezing, difficulty breathing and sometimes poor feeding or vomiting from thick nasal congestion and persistent coughing
  • Days 8-14 (sometimes longer): gradual recovery with slowly improving cough and wheezing

If you suspect your child has bronchiolitis, focus on consuming fluids and nasal suctioning. Our suctioning tip: use a couple of saline drops in each nostril followed by bulb suctioning, up to 3 times a day if nasal congestion is severe. This will temporarily clear nasal passages, giving you the opportunity to feed your child and for them to get some much needed sleep. Your child may not want to drink as much as usual, but an ounce or two of Pedialyte every one to two hours can take care of hydration in the short-term.

Despite our best efforts, some children with bronchiolitis require urgent medical care and even hospitalization. Seek medical attention if your child is:

  • breathing rapidly (count for 15 seconds – if you count more than 15 breaths, this is a cause for concern),
  • breathing with increased effort, especially pulling in under the ribcage or neck,
  • not making enough wet diapers (at least one every 6 hours),
  • turning blue around the mouth or lips or
  • is under two months of age and has a fever (rectal temperature over 100.4 degrees F).

Read more

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